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Why have so many New Jersey smokers quit?

On June 13th I wrote about a comprehensive new report on tobacco use and tobacco control activities in each of the United States. As I live and work in New Jersey I was particularly interested in the fact that our cigarette smoking rate has fallen to 13.7%, the 3rd lowest in the country. In fact if you look at the 2 other states with lower cigarette smoking rates (Utah and California) you will see that they also had lower rates than New Jersey (21.4%) back in 1992-3, meaning that New Jersey has probably had the most impressive reduction in cigarette smoking in the country over the past 15 years.

The other figure that caught my attention was that New Jersey has the highest proportion of ever cigarette smokers who have successfully quit (62%), as compared with the national average of 52% and the lowest figure for West Virginia (40.7%). A reader commented on my earlier post by asking me to say why I think smoking has come down so much in New Jersey. So here are my thoughts.

First of all, we should acknowledge that NJ had a good proportion of ex-smokers (54%) back in 1992-3. The proportion continued in parallel with national trends to 1998-9, but then NJ started to pull ahead in 2003 and 2006/7. So that makes me think that while the state has always been relatively health conscious, some things happened since 1999 that helped significantly. Now I’d like to say its all because I moved to the state in 2000 (I’m joking) but in reality there were far more important things going on.

New Jersey’s Comprehensive Tobacco Control Program really got started in 2000, with $30 million annual funding for a few years. The state actually invested that money very wisely in a truly comprehensive program with components for youth prevention, media, community activities, evaluation, and (unlike many states) New Jersey quickly invested in smoking cessation services. This included a free quitline ( 1-866-NJSTOPS ), an excellent internet site; www.nj.quitnet.com , and a bunch of face-to-face smoking cessation clinics called “NJ Quitcenters”. In addition they gave funding focusing on helping pregnant women and school kids to quit smoking and provided training activities for health professionals so they could do a better job of helping their patients to quit. For example, the program I direct has treated over 4,000 smokers but also trained over 4,000 health professionals to help smokers quit. So all of that activity has helped.

But there have been some additional critical policy or legislative moves that have undoubtably played a part. Perhaps the most important of these has been a series of increases in state excise tax on cigarettes. In fact just yesterday, Governor Corzine signed the 2009-10 budget that included an additional 12.5 cents tax per pack of cigarettes taking the total state tax per pack to $2.70. There can be no doubt that the resulting increase in the price of cigarettes over the past 9 years has prompted many smokers to try to quit. When that is combined with public education and quit services, it has a potent effect. In addition, New Jersey legislators have also passed a series of laws that have helped tobacco control. The age of sale of tobacco in New Jersey is 19, and in 2006 almost every workplace in the state (except a few areas in casinos and cigar bars) became smoke free. But that important change probably came too late to influence the 2006-7 data very much.

One other major event probably had a negative effect on quit rates in New Jersey and that was the terrorist attacks in September 2001. The Twin Towers in Manhattan, New York were visible from a large part of northern New Jersey, and many people in the north of the state work in New York City and knew people who were affected by those events. The evaluation component of the state’s tobacco control program, led by my colleague Dr Cristine Delnevo, actually reported an increase in cigarette smoking among people aged over 45 in 2001, and this may have been caused by an unusually large proportion of middle-aged ex-smokers relapsing at that time.

So despite a few setbacks, New Jersey has generally done a good job of making smoking less attractive and helping addicted smokers to quit. That’s the good news. But over the past few years, with budget deficits and the lure of tobacco taxes, funding for tobacco control was cut from $30m to $7.6m. Some legislators who were perhaps more interested in the budget than public health made pronouncements that we have done enough tobacco control in New Jersey. The reality is that school kids in our state still smoke over 90 million cigarettes per year and most adult smokers try to quit but fail each year.

I believe that if the NJ State Comprehensive Tobacco Control Program is properly funded we will have the lowest smoking rates in the country within a few years, along with plummeting rates of lung cancer, myocardial infarctions and premature births.

To view the new national report, check out:www.impacteen.org/tobaccodata.htm

To access a series of evaluation reports on tobacco control in New Jersey, check out:http://sph2.umdnj.edu/tobweb/Link%20to%20TSERP%20Reports.htm